Immunization

AIIMS ,PGI ,ALL INDIA QUESTION ,APPG AUESTIONS ,PAEDIATRCS

1. MCQ ‘S ON IMMUNIZATION VYDEHI VEERAMALLA MD BIOCHEMISTRY INDIA TELANGANA HYDERABAD

2. All of the following are true about measles vaccine except Given subcutaneously High efficacy Given below 1 year of age diluent not required D

3. It is a live attenuated vaccine Freeze dried product Hdc – edmonston zogreb strain 9 months of age undre national immunization programme Subcutaneously 0.5ml Reconstituted Diluting fluid kept at 4-8oc Reconstituted vaccine kept in ice Used with in one hour Immunity develops after 11- 12 days after vaccination Post exposure prophylaxsis possible if vaccine given within 3 days of exposure High efficacy .one dose gives 95%protection Immunity for life time Pregnancy is a contraindication since it is alive attenuated vaccine Contaminated vials causes toxic shock syndrome

4. Which vaccine is contraindicated In child with h/o of convulsions Dpt Measles Typhoid bcg A

5. Dpt vaccine is contraindicated in children with progressive neurological diseses In children with convulsion following first dose These contraindications are because of the pertissis component of the vaccine Contraindications to second dose Convlsions within 72 hrs Encephalopathy within 7 hrs Anaphylaxsis Hyporesponsive or hypotensive episode Hyperpyrexia with fever > 105 oF High pitch cry > 3 hrs

6. Contrindication for measles vaccine Pregnancy Acute illness Defecient cell mediated immunity Patients on steroids Contraindication to typhoid vaccine Pregnancy Immunosupression With in 24 hrs of antibiotic treatment Contrindication to bcg vaccine Immunosuppresion ,HIV

7. National immunization schedule All are involved except Tt Hepatitis b Opv measles B

8. National immunization schedule Birth – bcg,opv 0 dose 6 weeks- dpt opv 1 10 weeks- dpt opv 2 14 weeks dpt , opv 3 9 months measles 16-18 months- dpt opv booster 5 years – dt 10 years- tt 16 years- tt Pregnant women tt 2doses 4 weeks interval

9. Birth – bcg - , opv 0 dose 6 weeks- dpt opv 1 Hib , hep b 10 weeks- dpt opv 2 Hib , hep b 14 weeks dpt , opv 3 Hib , hep b 9 months - measles 16-18 months- dpt opv booster( Hib , Mmr 15- 18 months) 5 years – dpt , opv Hep b – birth,1,6 months Hep b – birth , 6, 14 weeks Indian academy of paediatrics

10. 10 years- tt 16 years- tt Pregnant women tt 2doses 4 weeks interval Measles 9 months + Typhoid 2 years ,revaccination at 3 years later

11. A 4 year old child presented in opd with vaccination historyOf receving one dose of opv and dpt at 2 months of age Correct statements are Bcg should not be given Dpt opv repeated Measles should be given Hepatitis b advised Haemophilus vaccine not given C,D

12. VACCINATION SCHEDULE OF UN IMMUNIZED CHILD

13. No vaccine should be administered within 4 weeks after measles / mmr A lapse in the immunization does not require reintiation of entire series Immunization schedule should be completed at the next available oppurtunity

14. Which vaccines are not given in a child of 8 yrs unimmmunized child Pertussis Salk vaccine Measles Bcg dt A,b,d

15. 18 months old child who has received one dose of dpt opv at 2months of age.what will be your next immunization plan. Restart immunization schedule as per age Measles , bcg boostr doase of dpt opv Measles,booster dose of dpt opv BCG ,2 ND DOSE OF DPT ,OPV D

16. Child would need further 2 doses of dpt , opv to complete primary immunization Booster doses are administered once primary immunization is complete

17. Contraindication to dpt is all except Local reaction to previous dpt High fever after previous dose Infantile spasms Seizuresafter previous dose A

18. Dpt is contraindication in Family h/o convulsions and neurological illness Upper respiratory infection Malnutrition Evoving neurological illness D

19. MMR VACCINE IS GIVEN AT BIRTH 6 MONTHS ONE YEAR ONE AND HALF YEAR D

20. ZERO DOSE OPV IS GIVEN AT BIRTH 1 MONTH 3 MONTHS 9 MONTHS A

21. EXCESSIVE CRYING IS SEEN AFTER WHICH VACCINATION POLIO DPT BCG MEASLES B

22. UN COMMON REACTION TO DPT PERTUSSIS COMPONOENT IS PROLONGED SCREAMING

23. WHICH OF THE FOLLOWING IS CONJUGATED VACCINE HEPATITIS B RUBELLA HAEMOPHILUS INFUENZA PERTUSIS

24. A  conjugate vaccine  is created by covalently attaching a poor (polysaccharide)  antigen  to a  carrier protein  (preferably from the same microorganism), thereby conferring the immunological attributes of the carrier to the attached antigen . B cell response to a capsular polysaccharide is T cell independent, meaning that B cells can produce antibodies without T cell stimulation .  By conjugating the polysaccharide to a protein carrier, a T cell response can be induced. Normally , polysaccharides by themselves cannot be loaded onto the MHC complex of antigen presenting cells (APC) because MHC can only bind peptides.

25. In the case of a conjugate vaccine, the carrier peptide linked to the polysaccharide target antigen is able to be presented on the MHC molecule and the T cell can be activated. T cells stimulate a more vigorous immune response and also promote a more rapid and long-lasting immunologic memory . This technique for the creation of an effective immunogen is most often applied to bacterial  polysaccharides   for the prevention of invasive bacterial disease.

26. Effective  vaccines for  Haemophilus influenzae  Type B have been available since the early 1990s, and is recommended for children under age 5 and asplenic patients. The   World Health Organization  recommends a pentavalent vaccine, combining vaccines against  diphtheria ,  tetanus ,  pertussis ,  hepatitis B  and Hib

27. Mechanisms of action Polysaccharide vaccine Haemophilus influenzae type b  is a bacterium with a polysaccharide capsule; the main component of this capsule is polyribosyl ribitol phosphate (PRP). Anti-PRP antibodies have a protective effect against Hib infections. Thus, purified PRP was considered a good candidate for a vaccine. However, the antibody response to PRP diminished rapidly after administration. This problem was due to recognition of the PRP antigen by B cells, but not T cells. In other words, even though B cell recognition was taking place, T cell recruitment (via MHC class II) was not, which compromised the immune response. This interaction with only B cells is termed T-independent (TI). This process also inhibits the formation of memory B cells, thus compromising long term immune system memory.  [9] [10 ]

28. Conjugate vaccine PRP covalently linked to a protein carrier was found to elicit a greater immune response than the polysaccharide form of the vaccine. This is due to the protein carrier being highly immunogenic in nature. The conjugate formulations show responses which are consistent with T-cell recruitment (namely a much stronger immune response). A memory effect (priming of the immune system against future attack by Hib ) is also observed after administration; indicative that memory B cell formation is also improved over that of the polysaccharide form. Since optimal contact between B cells and T cells is required (via MHC II) to maximize antibody production, it is reasoned that the conjugate vaccine allows B cells to properly recruit T cells, this is in contrast to the polysaccharide form in which it is speculated that B cells do not interact optimally with T cells leading to the TI interaction. HIB PRP CONJUGATE VACCINE IS AVIALBLE FOR HIB TYPE B

29. WHICH IS NOT GIVEN AT THE TIME OF BIRTH OPV BCG HEP B HIB D

30. WHICH ONE OF THE FOLLOWING ANTIBACTERIAL ARE NOT RECOMENDDED FOR LACTING MOTHER CEPHALOSPORIN ANTI TUBERCULAR DRUGS QUINOLONES AMINOGLYCOSIDE CIPROFLOXACIN SHOULD BE AVOIDED

31. Although ciprofloxacin has been shown to pass through breast milk in small amounts, it is unknown what effects this medication might have on a nursing infant. Because the drug may cause serious joint and muscle problems in infants and children, women should probably avoid the oral and intravenous forms of ciprofloxacin while breastfeeding.